CNN) – The Rev. Timothy McDonald gripped the pulpit with both hands, locked eyes with the shouting worshippers, and decided to speak the unspeakable.

The bespectacled Baptist minister was not confessing to a scandalous love affair or the theft of church funds. He brought up another taboo: the millions of poor Americans who won’t get health insurance beginning in January because their states refused to accept Obamacare.

McDonald cited a New Testament passage in which Jesus gathered the 5,000 and fed them with five loaves and two fishes. Members of his congregation bolted to their feet and yelled, “C’mon preacher” and “Yessir” as his voice rose in righteous anger.

“What I like about our God is that he doesn’t throw people away,” McDonald told First Iconium Baptist Church in Atlanta during a recent Sunday service. “There will be health care for every American. Don’t you worry when they try to cast you aside. Just say I’m a leftover for God and leftovers just taste better the next day!”

McDonald’s congregation cheered, but his is a voice crying in the wilderness. He’s willing to condemn state leaders whose refusal to accept Obamacare has left nearly 5 million poor Americans without health coverage. But few of the most famous pastors in the Bible Belt will join him.

Joel Osteen? Bishop T.D. Jakes, and other prominent pastors throughout the South?

Like McDonald, they preach in states where crosses and church steeples dot the skyline yet the poor can’t get the health insurance they would receive if they lived elsewhere. All declined to comment.

When people talk about the Affordable Care Act, most focus on the troubled launch of its website. But another complication of the law has received less attention: a “coverage gap” that will leave nearly 5 million poor Americans without health care, according to a Kaiser Health Foundation study.

The coverage gap was created when 25 states refused to accept the expansion of Medicaid under Obamacare. The people who fall into this gap make too much money to qualify for Medicaid and not enough to qualify for Obamacare subsidies in their state insurance exchanges. If they lived elsewhere, they would probably get insurance. But because they live in a state that refused the new health care law, they likely will remain among the nation’s uninsured poor after Obamacare coverage kicks in come January.

The coverage gap has been treated as a political issue, but there is a religious irony to the gap that has been ignored.

Most of the people who fall into the coverage gap live in the Bible Belt, a 14-state region in the South stretching from North Carolina to Texas and Florida. The Bible Belt is the most overtly Christian region in the country, filled with megachurches and pastors who are treated like celebrities. All but two Bible Belt states have refused to accept the Medicaid expansion under Obamacare.
Should Bible Belt pastors say anything publicly about the millions of poor people in their communities stranded by the coverage gap? Is it anti-Christian for state leaders to turn down help for the people Jesus called “the least of these"? Or should pastors say nothing publicly about such issues because they are strictly political?

CNN's Sanjay Gupta explains who falls into the coverage gap

Who speaks for the poor in the coverage gap?

When these questions were sent to many of the most popular pastors in the Bible Belt, they hit a wall of silence. Virtually no prominent pastor wanted to talk about the uninsured poor in their midst.

Joel Osteen, pastor of the largest church in the nation, declined to be interviewed about the subject. So did Bishop T.D. Jakes. Their megachurches are both in Texas, the state with the nation’s highest number of people without health insurance.

Max Lucado, the best-selling Christian author who is a minister at a church in Texas, declined to speak; Charles Stanley, the Southern Baptist pastor in Georgia whose In Touch Ministries reaches millions around the globe, declined to speak; Ed Young Sr. and Ed Young Jr., a father and son in Texas who pastor two of the fastest-growing churches in the nation, also declined to speak.

Bishop T.D. Jakes declined to talk about the millions of poor people stranded in the “coverage gap."

The list goes on.

The silence is not hard to understand. Obamacare is a polarizing political issue in the Bible Belt. A pastor who publicly weighs in on the subject could divide his or her congregation or risk their job. And some prominent pastors like Osteen are popular in part because they do not alienate fans by taking political stands.

The Rev. Phil Wages, senior pastor Winterville First Baptist Church in Georgia and a blogger, was one of the few Bible Belt ministers willing to speak on the subject.

He says he won’t preach about the coverage gap created by the state’s rejection of the Medicaid expansion because he has what he calls theological differences with the thrust of the new health care law.

Wages says the Bible teaches that the care of orphans, widows and the sick are given to the church, not to the government. Early Christians were the first to create hospitals, orphanages and hospices.

“I have an issue with the government coming in to get money through me - through taxes - to take care of people, when my argument is that I should be free to give to charities or to my church in order to take care of the sick and destitute,” he says.

Wages says he has no doubt that lack of health insurance is a monumental problem, and that many people are poor because of circumstances beyond their control. Yet there is no New Testament example of Jesus trying to shape public policy on behalf of the poor.

“I do not see any biblical precedent where Jesus ever went to Herod or Pilate and said you should be taking care of the poor,” Wages says. “Jesus told his disciples to take care of the poor and the apostles said the same thing to the early church.”

Wages’ position is impractical and unbiblical, says Ronald Sider, a longtime advocate for the poor and author of “The Scandal of Evangelical Politics."

Churches and charities don’t have enough resources to take care of an estimated 48 million Americans who don’t have health care. The Bible is filled with examples of God's fury over economic oppression of the poor, which Christians should regard as scandalous, he says.

“If you are not sharing God’s concern for the poor, it raises huge questions about whether you are a Christian at all,” he says about pastors who say nothing about the uninsured poor.

“As God’s spokespersons, you ought to be talking about God’s concern for the poor as much as God. In the richest nation in world history, it’s contradictory to have millions without health insurance.”

“It absolutely stinks”

The coverage gap may inspire a religious debate, but for its victims the issue is raw and personal.

A recent New York Times article about the coverage gap revealed that many of its victims are the working poor: cooks, cashiers, sales clerks and waitresses.

“These are people who are working people but they haven’t been able to afford health insurance or their employers don’t offer it and they’re stuck,” says Andy Miller, editor of Georgia Health News, a nonprofit news organization that covers health news in the state. “A lot of these folks have chronic health conditions.”

They are people like Shelley “Myra” Mitchell, a single mom with four children who makes $9 an hour working at a Chick-fil-A in Georgia. She makes $18,000 a year – too much for Georgia’s existing Medicaid program, but not enough to qualify for subsidies to sign up for Obamacare’s insurance marketplace in Georgia.

Mitchell’s voice grew edgy with frustration when asked to describe her health needs. She rang up about $20,000 in emergency room bills because she has no health insurance. She can’t afford to get pap smears, go to the dentist or get surgery for a two-year-old hernia. She can’t take medication for her depression and anxiety because she can’t afford it.

She thought she could get help under Obamacare but recently learned she can’t because Georgia did not accept the law’s Medicaid expansion.

“It stinks,” she says. “I’ve been dealing with this hernia for two years now, and I can’t get anyone to help me because I don’t have health insurance. It absolutely stinks.”

Why pastors should stay silent about the coverage gap

Mitchell’s plight may stink. But at what point should a pastor go public on such a complex issue, and what could he or she actually say?

Two prominent evangelical pastors openly wrestled with those questions.

Andy Stanley is one of the most popular evangelical pastors in the nation. He is the senior pastor of North Point Community Church in Alpharetta, Georgia, a megachurch with at least 33,000 members. He is also the author of the forthcoming book “How to be Rich,” which urges Christians to be "rich in good deeds" instead of wealth. His church recently announced that it donated $5.2 million to Atlanta charities and provided another 34,000 volunteer hours.

Joel Osteen has the largest church in America. He also declined to speak about the coverage gap.

Stanley says the coverage gap disturbs him. The church cannot handle the needs of millions of uninsured people alone and should quit taking shots at government involvement, he says. But he adds that it’s not anti-Christian for political leaders in states like Georgia to turn down the Medicaid expansion for the poor.

“If you really want to know how concerned someone is for the poor ask them what percentage of their personal money they give to organizations that help the poor,” he says. “Ask them how much time they give to organizations that help the poor.”

Stanley says it would be difficult for any pastor to talk about the Medicaid expansion without addressing the entire law.

“I tried to imagine a scenario where I urged people to write our governor encouraging him to reconsider his decision regarding the expansion of Medicaid for the poor,” he says. “As I imagined that, I got the feeling that by the time I finished explaining the issue, people’s eyes would be glazed over.”

Pastors who don't preach one way or the other on Medicaid expansion aren't callous or apathetic, says Russell Moore, president of the Southern Baptist Convention's Ethics & Religious Liberty Commission. They may be suspicious of a bigger government and skeptical of whether this move will solve the problem.

“The Bible calls on Christians to answer the cries of the poor,” he says. “All Christians must do that. The question of the Medicaid expansion is a question of how we do that. I don’t hear many people arguing that we shouldn’t care about the plight of the poor when it comes to medical care. The question is a genuine debate about the role of the state.”

Moore says some people have a “utopian view” of what state power can accomplish.

Bob Coy, pastor of Calvary Chapel megachurch in Fort Lauderdale, Florida, wondered aloud about what he could, and should, say.

Florida, which has the second highest number of people without health insurance behind Texas, has not accepted the Obamacare Medicaid expansion.

Coy says he hasn’t spoken publicly about poor people missing health coverage in Florida. But he has called the governor to get more information.

“I’m not an activist guy. I don’t tell the government what to do. I am a church guy. I teach the Bible.”

That doesn’t mean he doesn’t care for the poor, though, Coy says. He grew up in a poor family that couldn’t afford to go to the dentist. His church also spends a large percentage of its budget on serving the poor.

Coy says he is suspicious of large-scale programs that are publicly funded because they are often abused.

“One side of our society is saying, 'We need this,' while on the other side is saying, 'This isn’t fair and isn’t going to work.’ So how should a pastor, who has a heart to help people, respond?”

Why pastors should speak out

The Rev. Shane Stanford’s answer to Coy is simple: Talk about justice for the poor like Jesus did.

Stanford is the senior pastor of Christ United Methodist Church in Memphis and author of “Five Stones: Conquering Your Giants.”

He is also HIV-positive. He was born a hemophiliac and contracted the virus when he was 16 during treatment for his illness.

Stanford says he publicly speaks out about the millions of Americans stranded without health coverage because he knows how it feels. Once, after heart surgery, he was getting a transfusion when a nurse came into the room and pulled the needle out of his arm because she said he had maxed out his health insurance coverage.

He says standing up for people in the coverage gap is a matter of justice.

“Sometimes pastors have to tell people what they need to hear, not what they want to hear.”

Stanford ignores fellow pastors who counsel him to be silent about his state and others that refused to accept the Medicaid expansion.

“They say you have to be careful talking about political issues,” he says. “When I look at their lives, part of me thinks they never had that needle yanked out of their arm.”

Conservative pastors who urge their colleagues to avoid politics are hypocrites, says James Cone, a prominent theologian who has spent much of his career writing books condemning white churches for what he says is their indifference to social justice.

“When their own interests are involved, they are very much involved in politics,” Cone says. “Same-sex marriage and abortion – they have no trouble politically opposing them.”

Cone, a professor at Union Theological Seminary in New York, says a nation is defined by how it treats its most vulnerable members. But there is an entrenched hostility to poor people in America that goes unchallenged by some white, conservative Christians, he says.

“When poor people get food stamps, they get mad,” Cone says. “When the rich and corporations get tax breaks and pay no taxes, they don’t say anything.”

McDonald, the pastor who spoke out on behalf of poor people from his Atlanta church, says Jesus provided universal health care. The Gospels are filled with accounts of Jesus healing marginalized people.

“He did it for free,” McDonald says of Jesus’ healing. “The reason the crowds gathered around Jesus primarily was for healing. People want wholeness.”

Perhaps the gap between Bible Belt pastors who say nothing about the uninsured poor and those who do is also rooted in history.

Conservative Christians have traditionally emphasized providing charity to the poor - soup kitchens, donations to impoverished people in undeveloped countries - while progressive Christians have blended charity with calls for public policy changes that help the poor.

The distinction between both approaches was distilled by a memorable quote from the late Brazilian Roman Catholic Bishop Dom Helder Camara, who said: "When I feed the poor they call me a saint. When I ask why so many people are poor they call me a communist."

That may be changing as a new generation of evangelicals rise in the Bible Belt and elsewhere. One minister who speaks to them is the Rev. Timothy Keller, a conservative Christian author who pastors a megachurch in New York.

Keller is the author of “Generous Justice: How God’s Grace Makes Us Just,” a popular book that argues that evangelicals should do more than preach personal salvation; they must “speak up for those who cannot speak up for themselves.” He is a role model for many younger evangelicals.

“God loves and defends those with the least economic and social power, and so should we. That is what it means to ‘do justice.’ ’’

CNN.com recently contacted Keller to see if he would talk about "Generous Justice" and how it might apply to health care and the poor. Did he think pastors in Bible Belt states should say anything publicly on behalf of poor people being denied basic medical insurance? His publicist said she would contact Keller with the request.